Abstract
BackgroundTemporomandibular joint (TMJ) involvement occurs in up to 80% of patients with juvenile idiopathic arthritis (JIA). Currently there are no standardized procedures regarding diagnosis and treatment of this common complication of JIA. The aim of the study was to assess the current clinical practices in many countries regarding diagnosis and treatment of TMJ involvement in JIA. Pediatric rheumatologists were asked to fill out a survey with 8 items regarding diagnosis and treatment of TMJ involvement. The survey was distributed over the worldwide pediatric rheumatology electronic list-serve. Data was collected in an Excel spread sheet and analyzed using Excel software.FindingsEighty-seven centers responded to the survey between December 2009 and April 2010. All responding centers were actively screening for TMJ involvement. All centers were screening by physical exam, 85 (97%) by history, and 2 (3%) by imaging. Seventy-seven (88%) centers were screening at the first visit and 76 (87%) at each follow-up visit. If imaging was requested, 77% of the centers reported that they asked for MRI, 10% for ultrasound, 9% for CT and 33% for X-ray. The first line treatment of TMJ arthritis was a non-biologic DMARD in 36%, an NSAID in 33%, an intraarticular corticosteroid injection in 26%, and an anti-TNF agent in 5%. Overall, 57 (65%) of the centers were using intraarticular corticosteroid injections as treatment.ConclusionsTMJ arthritis is common among children with JIA. This survey shows that a wide array of diagnostic and therapeutic approaches is being employed for TMJ disease in 87 international centers. Due to this lack of agreement in how to diagnose and treat this JIA complication, we believe that an expert opinion/consensus statement regarding TMJ arthritis in JIA will likely benefit patients worldwide.
Highlights
Temporomandibular joint (TMJ) arthritis is common among children with juvenile idiopathic arthritis (JIA)
Due to this lack of agreement in how to diagnose and treat this JIA complication, we believe that an expert opinion/consensus statement regarding TMJ arthritis in JIA will likely benefit patients worldwide
Eighty-five of the 87 centers screened for TMJ arthritis by history, and all responding centers screened by physical exam
Summary
Temporomandibular joint (TMJ) involvement occurs in up to 80% of patients with juvenile idiopathic arthritis (JIA). In clinical experience TMJs appear to respond less well to the standard of care used to treat other joints This is reflected in the study populations of Ringold et al [6] and Arabshahi et al [7]. In these studies, a large proportion of patients received a DMARD plus antiTNF treatment, and despite these therapies, patients developed TMJ arthritis. A large proportion of patients received a DMARD plus antiTNF treatment, and despite these therapies, patients developed TMJ arthritis These publications included intraarticular corticosteroid treatment of TMJ arthritis and demonstrated a response in subsets of the JIA patients [6,7], but not all of the treated JIA patients regain a normal mouth opening. To gain more information about the current practice standards regarding diagnosis and medical management of TMJ arthritis in children with JIA, a multinational email survey was conducted
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